Deep brain stimulation: a mechanistic and clinical update

Karas, Patrick J.; Mikell, Charles B.; Christian, Eisha; Liker, Mark A.; Sheth, Sameer A.

doi:10.3171/2013.9.focus13383

Cited by 46 publications

(39 citation statements)

References 213 publications

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“…Similarly, bioelectric and direct nerve–electrode interface technology has already made its way into routine clinical practice. Vagal nerve and deep brain stimulators are frequently implanted into patients to effectively treat a variety of common neurologic and psychiatric pathologies. Chronic spinal cord stimulators are likewise in routine use for patients with severe neuropathic pain recalcitrant to conservative, noninvasive therapy .…”

Section: Discussionmentioning

confidence: 99%

Selective stimulation of facial muscles with a penetrating electrode array in the feline model

et al. 2016

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Objective Permanent facial nerve injury is a difficult challenge for both patients and physicians given its potential for debilitating functional, cosmetic, and psychological sequelae. Although current surgical interventions have provided considerable advancements in facial nerve rehabilitation, they often fail to fully address all impairments. We aim to introduce an alternative approach to facial nerve rehabilitation. Study design Acute experiments in animals with normal facial function. Methods The study included three anesthetized cats. Four facial muscles (levator auris longus, orbicularis oculi, nasalis, and orbicularis oris) were monitored with a standard electromyographic (EMG) facial nerve monitoring system with needle electrodes. The main trunk of the facial nerve was exposed and a 16-channel penetrating electrode array was placed into the nerve. Electrical current pulses were delivered to each stimulating electrode individually. Elicited EMG voltage outputs were recorded for each muscle. Results Stimulation through individual channels selectively activated restricted nerve populations, resulting in selective contraction of individual muscles. Increasing stimulation current levels resulted in increasing EMG voltage responses. Typically, selective activation of two or more distinct muscles was successfully achieved via a single placement of the multi-channel electrode array by selection of appropriate stimulation channels. Conclusion We have established in the animal model the ability of a penetrating electrode array to selectively stimulate restricted fiber populations within the facial nerve and to selectively elicit contractions in specific muscles and regions of the face. These results show promise for the development of a facial nerve implant system.

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Section: Discussionmentioning

confidence: 99%

Selective stimulation of facial muscles with a penetrating electrode array in the feline model

et al. 2016

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“…Furthermore, the application of direct nerve stimulation for patients with disuse muscle atrophy, multiple sclerosis, and spinal cord injury is currently underway . Direct stimulation of the nervous system can also address other pathologies . Chronic spinal cord stimulation, for example, has been shown to alleviate severe neuropathic pain .…”

Section: Introductionmentioning

confidence: 99%

“…7 Direct stimulation of the nervous system can also address other pathologies. 8,9 Chronic spinal cord stimulation, for example, has been shown to alleviate severe neuropathic pain. 10 Moreover, selective stimulation of nerve roots with a Finetech-Brindley neurostimulator has been shown to improve bladder, bowel and sexual function in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Functional and Histological Effects of Chronic Neural Electrode Implantation

Sahyouni

Chang

Moshtaghi

et al. 2017

Laryngoscope Investig Oto

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ObjectivesPermanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation. Data Sources: PubMed, IEEE, and Web of Science literature search. Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants.ResultsBioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve‐specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant.ConclusionA variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic.Level of Evidence3.

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“…; Karas et al . ). Despite some discrepancies, literature data suggest that STN HFS modulates glutamatergic and GABAergic neurotransmission in the striatum, GPi/SNr and cortex (Bruet et al .…”

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confidence: 97%

Metabolic, synaptic and behavioral impact of 5‐week chronic deep brain stimulation in hemiparkinsonian rats

Chassain

Melon

Salin

et al. 2015

Journal of Neurochemistry

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The long-term effects and action mechanisms of subthalamic nucleus (STN) high-frequency stimulation (HFS) for Parkinson's disease still remain poorly characterized, mainly due to the lack of experimental models relevant to clinical application. To address this issue, we performed a multilevel study in freely moving hemiparkinsonian rats undergoing 5-week chronic STN HFS, using a portable constant-current microstimulator. In vivo metabolic neuroimaging by 1 H-magnetic resonance spectroscopy (11.7 T) showed that STN HFS normalized the tissue levels of the neurotransmission-related metabolites glutamate, glutamine and GABA in both the striatum and substantia nigra reticulata (SNr), which were significantly increased in hemiparkinsonian rats, but further decreased nigral GABA levels below control values; taurine levels, which were not affected in hemiparkinsonian rats, were significantly reduced. Slice electrophysiological recordings revealed that STN HFS was, uniquely among antiparkinsonian treatments, able to restore both forms of corticostriatal synaptic plasticity, i.e. long-term depression and potentiation, which were impaired in hemiparkinsonian rats. Behavior analysis (staircase test) showed a progressive recovery of motor skill during the stimulation period. Altogether, these data show that chronic STN HFS efficiently counteracts metabolic and synaptic defects due to dopaminergic lesion in both the striatum and SNr. Comparison of chronic STN HFS with acute and subchronic treatment further suggests that the long-term benefits of this treatment rely both on the maintenance of acute effects and on delayed actions on the basal ganglia network.

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Deep brain stimulation: a mechanistic and clinical update

Cited by 46 publications

References 213 publications

Selective stimulation of facial muscles with a penetrating electrode array in the feline model

Selective stimulation of facial muscles with a penetrating electrode array in the feline model

Functional and Histological Effects of Chronic Neural Electrode Implantation

Metabolic, synaptic and behavioral impact of 5‐week chronic deep brain stimulation in hemiparkinsonian rats

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